Is It Always Best When The Doctor Gets Involved?

An Opinion piece by Malcom Evans

Shocking statistics released in the UK show that during 2006 doctors made over 31 million prescriptions of antidepressant pills.

The exact number of patients this equates to can only be guesstimated but is reckoned to run into the several million. Similar generalizations from the US indicate that possibly between 1 in 4 and 1 in 5 of all US citizens may be prescribed antidepressants within their lifetime.

Comparative studies often show a broadly similar pattern of effectiveness in treating depression between pills and talk therapies. Many pills have indications of worrying problems, from dependency through to unpleasant side effects.

Whatever the efficacy of these antidepressant pills themselves, they highlight a worrying trend in public health – medicalization, which is the placing within the authority of medical treatment certain issues which may well better be viewed and tackled as more complex social phenomena.

There is a strong case to be made that treating long term depression with long term pill prescription is not treatment at all, just camouflage, papering over the cracks.

Some political scientists in the West view medicalization as a symptom of broader developments, whereby late-capitalist states, relatively wealthy, stable and mature as they have become, are forever seeking to expand the boundaries of their control.

As one example, the general process is reflected in ever stricter measures with regards to road regulations, where the trend is for ever lower speed limits, ever lower drink drive limits, ever more casual parking opportunities removed from town and city streets.

And we see this process of command and control ever more obviously in public healthcare, expressed in the specific mode of medicalization, increasingly backed up with creeping sanctions of criminalization.

Medicalization can be found throughout the issue of anti-social behaviour. Young people, often of a very clearly defined socioeconomic status within very similar city estates, are referred to anger management and drink and drug use sessions as a result of their rowdy, disruptive and sometimes violent activities. Resources are being poured into their expressions through behaviours; some might say the main focus and main spending is being directed at the symptoms, not the causes.

It happens within the area of teenage pregnancies, whereby the main focus of attention becomes birth control, not an analysis of why some identifiable groups of teenage women tend to value early motherhood higher than others.

And it most certainly is happening with weight loss and control issues. Here the failure is to address the overwhelming paradox whereby the mass obsession with dieting continues to grow alongside the rising and general understanding that dieting is in fact a poor method of long term weight control; indeed, obsessive dieting can be shown to be a contributory factor in growing overweight.

Yet public healthcare remains reluctant to tackle the broad stroke and rather complex collage which makes up the overall weight control picture. This is reflective of the overall trend that whilst governments like control, they are generally poorly equipped to tackle complexity.

We are now seeing legislation coming in against junk food promotion and even against parents who are deemed poor feeders of their children. However, all the pressure and exhortations towards the individual are towards dieting as the answer to all weight problems.

Pills, prescriptions, proscriptions and public healthcare are all part and parcel of a medicalization juggernaut which is pushing other arguments aside. It is time to slow down, step back and to indulge in some good old fashioned social analysis about what may be a more efficacious balance between State leadership and individual responsibility, between legislation and education, and between micro and macro intervention.